Does Canada Need a Loneliness Strategy?

CBC National recently asked this question.

They note:

Britain recently appointed a cabinet minister to try and find a solution for an increasing number of people who say they’re lonely. About 200,000 seniors in the U.K. say they haven’t had a conversation with a friend or relative in more than a month.

I was interviewed in the story.

The full clip here:

http://www.cbc.ca/news/thenational/does-canada-need-a-loneliness-strategy-1.4492553

Reading of the Week: More Demand, Less Physician Care? The New Chiu et al. Paper. Also, CAMH’s Really Big Donation

From the Editor

Canadians understand more about mental health and – with declining stigma – are more interested in services. So are they using more services and how have practice patterns changed with time?

In this week’s Reading, we consider a new paper from The Canadian Journal of Psychiatry. Chiu et al. try to answer these questions by looking at outpatient family doctor and psychiatrist visits from 2006 to 2014. They also look at ED visits and hospitalizations.

8b16181v-565x422Family docs and mental health: how much care do they deliver (and are all their patients this cute)?

They find that ED visits were up for mental health, as were hospitalizations, but physicians visits went down (all in terms of rates). They write: “The increasing acute care service use coupled with the reduction in outpatient visits suggest, overall, an increase in demand for mental health care that is not being met in ambulatory care settings.”

Also in this week’s Reading, we consider some good news: CAMH received a $100 million gift from an anonymous donor. Good news – but is it all good news for mental health charities?

DG

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Reading of the Week: Mental Health’s Funding Problem – the New Wang Paper; Also, the Life of Jimmie Holland

From the Editor

As we start 2018, additional funding for mental health care is widely discussed.

But what are current funding levels? How have they changed over the past decade? Which provinces are funding more and which are funding less? A new paper just published by The Canadian Journal of Psychiatry attempts to answer these questions. While the paper looks at different aspects of funding, it reaches a surprising conclusion: between 2003 and 2013, “the percentage of mental health costs with respect to total provincial public health care expenditures decreased overall…”

In this Reading, we review that paper and consider the broader implications.

In the second selection, we consider the life and contributions of Dr. Jimmie Holland, who recently passed. Dr. Holland has been called the “mother” of psycho-oncology.

DG

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Reading of the Week: The Best of 2017

From the Editor

No one should feel abandoned when their child is in a mental health crisis. Yet, sadly, I’ve met with families who’ve felt like they were. I’ve met with families who have had the courage to seek help, and have been sent away. I’ve heard of cases where brave souls have come forward, but without accessible and timely [care], have taken their own lives. I know of cases where parents miss out on work to support their kids. And where 18 year olds fall through the gaps when transitioning to adulthood.

It’s an annual tradition. At the end of each year, we take stock, reviewing the best of the past year.

And this past year has been remarkable in terms of good news.

Consider:

  • Earlier this year, the federal and provincial governments agreed to big investments in mental health.
  • In December, the Quebec Minister of Health committed his province to publicly funded psychotherapy for people with depression and anxiety provided by nurses, social workers and psychologists.
  • Ontario had made a similar if smaller commitment in the fall.

And the political push for mental health reform continues. Just this past weekend, Ontario PC Leader Patrick Brown wrote the above quotation in an opinion piece for the Postmedia Network. He called for a massive infusion of money into the mental health care system above the federal commitment.

The promises are big, but paper after paper shows that there is much work to be done. Studies this year found people with schizophrenia die at a rate eight times higher than that of the general population; that ECT use is declining despite its efficacy; that the vast majority of people post-suicide attempt aren’t seen by a psychiatrist within six months.

And so, we end 2017 in an usual position – those of us in mental health who have longed for a day when funding would improve and political interest would grow can feel satisfied. We should also feel a bit anxious. We now have a remarkable opportunity. We shouldn’t waste it.

And so with an eye on the future, let’s look back at the last year. In this final Reading of 2017, there are six selections, covering everything from the effectiveness of antipsychotics to the journey of a great uncle through Ohio asylums. Enjoy.

Please note that there will be no Reading next week.

DG

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Our Globe Essay: “For better mental-health care in Canada, look to Britain”

It may be the biggest change to mental-health-care services in five decades. Earlier this month, Quebec Minister of Health Gaétan Barrette announced that his province would publicly fund psychotherapy for people with depression and anxiety provided by psychologists, nurses and social workers. Ontario made a similar, if smaller, promise earlier this year and other provinces are considering similar initiatives. But how can we turn these big promises into big help for the hundreds of thousands of Canadians who could benefit? Two words of advice: go British.

So begins my new op ed, co-written with CAMH’s David Goldbloom, from Monday’s Globe and Mail.

The full piece can be found here:

https://www.theglobeandmail.com/opinion/for-better-mental-health-care-in-canada-look-to-britain/article37358415/

Reading of the Week: Better Pay, Better Service? The CMAJ Paper on Pay for Performance in Psychiatry. Also, a Father’s Memory

From the Editor

Does pay for performance work for psychiatry?

This week’s first selection is a paper just published by CMAJ that considers that question. Drawing on Ontario data, the authors looked at practice patterns when financial incentives were introduced for psychiatrists to take care of patients after discharge and after suicide attempts. Spoiler alert: they didn’t work.

http-i-huffpost-com-gen-1291505-images-n-free-health-care-canada-628x314Paying for Performance – Getting Performance?

In this Reading, we consider the paper and the larger debate.

We also consider a short, moving essay by radio host Charles Adler on the memory of his father – and his father’s memory. The award-winning broadcaster describes his father and his Alzheimer.

DG

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Reading of the Week: Ethics & Medical Assistance in Dying – the new Simpson Paper. Also, Exercise for the Cognitive Symptoms of Depression?

From the Editor

It may soon be the law… but is it ethical?

In 2016, Parliament passed Bill C-14, legalizing doctor-assisted suicide. The legislation represents a major change in many ways: from public policy to the practice of medicine. And, in the coming years, it’s quite possible that the scope of this legislation will be expanded, and could include those with mental illness.

In this week’s Reading, Dr. Wayne (Sandy) Simpson of CAMH weighs in on the ethics of medical assistance in dying (MAiD) and mental illness in this provocative “perspective” paper just published by The Canadian Journal of Psychiatry. He considers the nature of mental illness before concluding: “[A]cting as a partner in helping people recover as well as acting as an agent in a patient’s death is an impossible burden that is not ethically justifiable or legally necessary.”

ethics-cert

Also, this week, we consider another recent paper by The Canadian Journal of Psychiatry that considers the impact of exercise on cognition in patients with depression.

DG

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Reading of the Week: Do Patients with Cancer Struggle with PTSD? Yes – the new Cancer Paper. Also, Quebec Covers Therapy

From the Editor

I spent a dozen years working at a community hospital. One of my richest experiences was working with cancer patients and their families. For so many patients, not surprisingly, cancer isn’t just a physical illness, but a psychiatric one, too – patients often experience depression and anxiety.

How common is PTSD in cancer patients? Surprisingly little work has been done in the area. In this week’s Reading, we look at a new study that considers PTSD and cancer. The study is particularly impressive in that patients were followed for years after diagnosis.

Big diagnosis, big treatment, big psychiatric problems?

In this Reading, we consider the paper and its findings.

And, with an eye on treatment for those with or without cancer, we consider a good news story: on Sunday, the Quebec government committed itself to cover psychotherapy for those with depression and anxiety in the public system.

DG

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Reading of the Week: Is AVATAR Therapy a Breakthrough for Those Who Hear Voices? The New Lancet Psychiatry Paper

From the Editor

“The voices won’t leave me alone.”

A patient made this comment to me recently. And it’s an experience many patients have had. Despite medications and follow up, the voices continue to be problematic.

This week, we look at a new paper from The Lancet Psychiatry which considers a novel approach: AVATAR therapy.

In this study, patients who experienced auditory hallucinations created a computerized simulation (avatar) of the voice they most wanted to influence, including what the voice said, how it sounded, and how the “entity” with the voice looked like. Patients, working with a therapist who controlled the avatar, then had therapy sessions in which they could talk to it. Patients were compared on several measures to those who only received supportive therapy.

The paper has received significant media attention including CNN and BBC.

1124avatar2The Face of the Voice – and a Step Toward Healing?

Spoiler alert: the therapy helped – at least initially – but the results are complicated. (And, no, this isn’t “fake news,” to borrow a phrase from an American politician.)

In this Reading, we consider the paper and its findings.

DG

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Reading of the Week: The Pill That Talks to Doctors, & More

From the Editor

The pill. The criticism. The question.

Readings have covered everything from new books to political speeches. This week, we consider a few thought-provoking pieces. Is there a common theme? Maybe this: the world of mental health care is changing – and fast.

In these three selections, we look at: the pill that talks to doctors and family, the criticism of digital health, the question about the true nature of schizophrenia.

Enjoy.

DG

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